Paradoxical vocal fold motion dysfunction in asthma patients

Respirology. 2009 Jul;14(5):729-33. doi: 10.1111/j.1440-1843.2009.01568.x.


Background and objective: Paradoxical vocal fold motion dysfunction (PVFMD) is a disorder of the larynx characterized by adduction of the vocal cords during the respiratory cycle leading to symptoms of extrathoracic airway obstruction. PVFMD mimics asthma and patients with PVFMD (PVFMD+) are often diagnosed incorrectly as refractory asthma and receive unnecessary treatment. This study determined the prevalence of PVFMD in asthma patients and described the relationship between asthma and PVFMD.

Methods: A descriptive study of 94 asthmatic patients and 40 control subjects, all of whom were examined via laryngoscopy and had pulmonary function tests were performed.

Results: The prevalence of PVFMD was 19% (n = 18) in the asthmatic group and 5% (n = 2) in the control group (P < 0.001). No relationship was found between presence of PVFMD, asthma attacks and asthma severity (P > 0.05). Laryngopharyngeal reflux and allergy were significantly more prevalent in the PVFMD+ group than in the group without PVFMD (PVFMD-) (P < 0.05). The most common symptoms in the PVFMD+ patients were difficulty in breathing (88%), inspiratory stridor (66%) and a choking sensation (50%) and the most common symptoms in PVFMD- asthmatic patients were cough (63%), dyspnoea (55%) and wheezing (51%).

Conclusions: Asthma seems to facilitate the formation of the paradoxical dysfunction in the larynx as the prevalence of PVFMD in asthma patients is significantly higher than in patients with out asthma.

MeSH terms

  • Adult
  • Aged
  • Asthma / complications*
  • Asthma / diagnosis
  • Asthma / physiopathology*
  • Case-Control Studies
  • Cough / etiology
  • Diagnosis, Differential
  • Dyspnea / etiology
  • Female
  • Humans
  • Laryngeal Diseases / diagnosis
  • Laryngeal Diseases / epidemiology*
  • Laryngeal Diseases / physiopathology*
  • Laryngoscopy
  • Male
  • Middle Aged
  • Prevalence
  • Respiratory Function Tests
  • Respiratory Sounds / etiology
  • Risk Factors
  • Severity of Illness Index
  • Vocal Cords / physiopathology*